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PTSD: SUFFERING DIFFERENTLY -- The simple but
surprising
truth appears to be that symptoms of
psychological trauma can
be both culturally created and utterly real to
the individual at the
same time. A diagnosis like PTSD can be real in
a particular
place and time and yet not be true for all
places and times.
For more on PTSD, use the VA Watchdog search
engine...click here...
http://www.yourvabenefits.org/ses
search.php?q=PTSD&op=and
Story here...
http://www.nytimes.com/2007
/08/12/magazine/12wwln-idealab-t.html?
_r=1&ref=magazine&oref=slogin
Story below:
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Suffering Differently
By ETHAN WATTERS
After the 2004 tsunami in Asia, many mental-health experts agreed that a
“second tsunami” of mental illness in the form of post-traumatic stress
disorder would strike the region. Like doctors rushing to the outbreak
of an epidemic, American counselors and trauma researchers soon arrived
on the scene hoping to pass on useful knowledge about PTSD. A few years
on, however, their efforts have raised a troublesome question: Were they
bringing the wrong treatment to the wrong people?
At issue is not whether tragic events like the tsunami trigger
debilitating psychological distress and even mental illness — everyone
agrees that they can. The question is over the extent to which
survivors’ cultural beliefs shape their symptoms. If culture has the
impact that some researchers suggest, the PTSD diagnosis may be of
little help (and even do potential harm) when applied wholesale in other
countries.
In the last 25 years, PTSD has had a remarkable ascendancy in American
psychiatry and in public consciousness. Proponents of the diagnosis
assert that experiences of fear or horror often spark a cluster of 17
broad symptoms, including intrusive thoughts, memory avoidance and
uncontrollable anxiety. The concept of PTSD also encompasses notions of
how best to overcome the disorder, usually through measured re-exposure
to the original trauma supervised by a counselor. PTSD, many Americans
assume, describes the way that all humans react to trauma.
Gaithri Fernando, an expert on trauma from California State University,
questions that assumption. “Researchers and counselors who came to Sri
Lanka after the tsunami did find some PTSD symptoms,” Fernando says.
“But it was not the nightmares or flashbacks that most of the population
was concerned with. The deepest psychological wounds for Sri Lankans
were not on the PTSD checklists; they were the loss of or the
disturbance of one’s role in the group.”
Ken Miller, a psychology professor at Pomona College, reached similar
conclusions in his work on war-related trauma in Guatemala, Bosnia and
Afghanistan. His study of Afghans who experienced trauma yielded 23
symptoms, including many that were not on the PTSD symptom list and
several that had no ready translation into English. There was, for
instance, “asabi,” a type of nervous anger, and “fishar-e-bala,” the
mental sensation of internal stress or pressure. Researchers studying
other cultures have also found deviations from the PTSD symptom list.
Salvadoran female refugees who endured the protracted civil war often
experienced calorias, a feeling of intense heat in their bodies. When
Cambodian refugees were asked about the most pressing psychological
impact of trauma, they told of nighttime visits by vengeful spirits.
The simple but surprising truth appears to be that symptoms of
psychological trauma can be both culturally created and utterly real to
the individual at the same time. As the anthropologist Allan Young of
McGill University explains, a diagnosis like PTSD “can be real in a
particular place and time and yet not be true for all places and times.”
Cultural differences can also be found in the beliefs about how people
heal. Many East Africans, for instance, hold that the ability not to
talk about distressing experiences is a sign of maturity. This runs
counter to the typical assumption of trauma counselors that a healing
catharsis can be achieved through “truth telling.” In Sri Lanka,
Fernando says, the idea of splitting off from the group to heal psychic
wounds through individual counseling can actually exacerbate the more
salient fear of social isolation. To understand how strange and
disconcerting it might be to have another culture import its form of
trauma healing, Miller says, you need only consider the situation
reversed. “Imagine our reaction,” he says, “if Mozambicans flew here
after 9/11 and began telling survivors to engage in a certain set of
mourning rituals in order to sever their relationship with their
deceased family members.”
Instead of imposing outside assumptions about trauma and healing, the
World Health Organization has begun recommending “psychosocial support”
for disaster areas. The assumption is that just as cultures have their
own symptoms of trauma, they have distinct healing methods that are
often tied to local rites. For every angry ghost, there is a ritual for
the dead intended to lay that ghost to rest.
If we’re unaware of the local idioms of suffering, Miller and other
researchers argue, our assistance is likely to be ineffective at best.
The worst-case scenario is that such interventions pressure other
cultures to adopt Western beliefs about the meaning and impact of
trauma. “PTSD has become psychiatric Esperanto,” Young says mordantly.
“It may turn out to be the greatest success story of globalization.”
Ethan Watters, a writer based in San Francisco, is the author of “Urban
Tribes: Are Friends the New Family?”
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Larry Scott --
